USPSTF Updates Lead Level Screening Recommendations for Children

The US Preventive Service Task Force sought to update the 2006 recommendations on screening for elevated blood lead levels in asymptomatic children and pregnant women.

An updated US Preventive Services Task Force (USPSTF) recommendation states that the current evidence is insufficient to assess the benefits and harms of screening for elevated blood lead levels in asymptomatic children age ≤5 years, both at average and increased risk, as well as in pregnant women. The guidelines were published in JAMA.1

Researchers sought to update the 2006 USPSTF screening
recommendations, as elevated blood lead levels may be associated with
neurologic effects in children and organ failure and preeclampsia in pregnant
women.

Capillary blood testing was confirmed as the method to accurately
identify children with elevated blood lead levels compared with venous blood
testing. Questionnaires and other clinical predication tools were found to be
inaccurate in identifying elevated blood lead levels in asymptomatic children
or communities at highest risk, while no determination could be made regarding
the accuracy of these tools in identifying elevated blood lead levels in
asymptomatic pregnant women.

The USPSTF found inadequate evidence on the effectiveness of screening
for or treatment of elevated blood lead levels in asymptomatic children age ≤5
years or pregnant women. Inadequate evidence was found as to whether the
effectiveness of screening pregnant women varies by gestational age.

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In an accompanying editorial published in
JAMA Pediatrics,2 author
Michael Weitzman, MD, concludes, “The inconclusive findings of the new USPSTF
recommendation does not mean that screening children for elevated lead levels
is not necessary, nor does it shed light on whether screening should be
targeted to children at high risk or whether it should be universally done.
Only more rigorously conducted research will provide evidence-based answers to
these questions.”